Provider Demographics
NPI:1750658290
Name:HALPERN, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HALPERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 JAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1037
Mailing Address - Country:US
Mailing Address - Phone:516-729-8930
Mailing Address - Fax:
Practice Address - Street 1:6435 102ND ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3658
Practice Address - Country:US
Practice Address - Phone:718-897-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0131861251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)